Prenatal Depression Screening and Follow-up (PND-E)

The percentage of deliveries in which members were screened for clinical depression while pregnant and, if screened positive, received follow-up care. Two rates are reported.

1. Depression Screening: The percentage of deliveries in which members were screened for clinical depression during pregnancy using a standardized instrument.
2. Follow-Up on Positive Screen: The percentage of deliveries in which members received follow-up care within 30 days of a positive depression screen finding.

Why it Matters

Major depressive disorder (MDD) is the second leading cause of disability worldwide, affecting an estimated 120 million people.¹ The lifelong prevalence is estimated to range from 10%–15%. ² In the United States, 16% of people report that at some point in their lifetime they were told by a health care professional that they had depression.³

In adolescents, depression can also result in serious long-term morbidities such as generalized anxiety disorder and panic disorder, or lead to engagement in risky behaviors such as substance use.^{4, 5, 6, 7} Adolescent-onset depression increases the risk of attempted suicide five-fold in comparison with nondepressed adolescents.⁸ Most adolescents who commit suicide, the third leading cause of death among 15–24 year-olds, have a history of depression.⁹

Perinatal depression refers to minor and major depression episodes during pregnancy and/or the first 12 months after childbirth and is a common condition that affects functional outcomes both for affected women and for their families.¹⁰ Rates of depression for pregnant and/or postpartum women range from 12%-15%, with postpartum depression rates in some U.S. areas estimated to be as high as 20%.¹¹ Women with untreated depression during pregnancy are at risk for developing severe postpartum depression and suicidality, and of delivering premature or low birth-weight infants. ¹² Postpartum depression hinders important caregiving activities and infant attachment and bonding, which can lead to developmental disorders that last into adolescence. ^{13, 14, 15}

Studies have found that patient outcomes improve when there is collaboration between a primary care provider, case manager and a mental health specialist to screen for depression, monitor symptoms, provide treatment and refer to specialty care as needed. ^{16, 17, 18}

*Developed with support from the California HealthCare Foundation (CHCF). CHCF works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf org to learn more. Also supported by the Zoma Foundation.

Results

NCQA published a special report summarizing HEDIS measurement year 2020 results for eight measures that leverage electronic clinical data, including this measure. This report can be found here: www.ncqa.org/ecds.

References

1. Murray, C.J.L., T. Vos, R. Lozano, M. Naghavi, A.D. Flaxman, C. Michaud, M. Ezzati, et al. 2013. “Disability-Adjusted Life Years (DALYs) for 291 Diseases and Injuries in 21 regions, 1990–2010: a Systematic Analysis for the Global Burden of Disease Study 2010.” The Lancet 380(9859):2197–23.
2. Lépine, J.P., M. Briley. 2011. “The Increasing Burden of Depression.” Neuropsychiatric Disease and Treatment 7(suppl 1):3–7.
3. Centers for Disease Control and Prevention. 2009. “Anxiety and Depression Effective Treatments Exist: People with Depression and Anxiety Should Seek Help as Early as Possible to Reduce Health Effects and Improve Quality of Life. Based on 2006 Behavior Risk Factor Surveillance System.” www.cdc.gov/Features/dsBRFSSDepressionAnxiety
4. Taylor, E. et al. 1996. “Hyperactivity and Conduct Problems as Risk Factors for Adolescent Development.” Journal of the American Academy of Child and Adolescent Psychiatry 35:1213–26.
5. Foley, H.A., C.O. Carlton, R.J Howell. 1996. “The Relationship of Attention Deficit Hyperactivity Disorder and Conduct Disorders to Juvenile Delinquency: Legal Implications.” Bulletin of the American Academy of Psychiatry Law 24:333–45.
6. Friedman, R.M., J.W. Katz-Levey, R.W Manderschied, D.L. Sondheimer. 1996. “Prevalence of Serious Emotional Disturbance in Children and Adolescents.” In: Manderscheid, R.W., and M.A. Sonnenschein (eds.) Mental Health. United States. Rockville, MD: Center for Mental Health Services, 71-8.
7. O’Connell, M.E., Boat, T., Warner, K.E. 2009. “Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and possibilities.” National Research Council and Institute of Medicine. http://www.whyy.org/news/sci20090302Mentalprepub.pdf
8. Garber, J. et al. 2009. “Prevention of Depression in At-Risk Adolescents: A Randomized Controlled Trial.” Journal of the American Medical Association 301(21):2215–24.
9. Williams, S.B., E.A. O’Connor, M. Eder, E.P. Whitlock. 2009. “Screening for Child and Adolescent Depression in Primary Care Settings: A Systematic Evidence Review for the US Preventive Services Task Force.” Pediatrics 123(4):e716-e735.
10. Gaynes, B.N., N. Gavin, S. Meltzer-Brody, et al. 2005. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes: Summary. Bethesda, MD: National Center for Biotechnology Information, 2005: 1–8.
11. Ko, J.Y., K.M. Rockhill, V.T. Tong, B. Morrow, S.L. Farr. 2017. “Trends in Postpartum Depressive Symptoms—27 States, 2004, 2008, and 2012.” MMWR Morb Mortal Wkly Rep 66: 153–8. doi: http: //dx.doi.org/10.15585/mmwr.mm6606a1.
12. Chan, J., A. Natekar, A. Einarson, and G. Koren. 2014. “Risks of Untreated Depression in Pregnancy.” Can Fam Physician Mar; 60(3): 242–3.
13. Field, T. 2010. “Postpartum Depression Effects on Early Interactions, Parenting, and Safety Practices: A Review.” Infant Behav Dev 33(1): 1–6.
14. Gregory, E.F., A.M. Butz, S.R. Ghazarian, S.M. Gross, S.B. Johnson. 2015. “Are Unmet Breastfeeding Expectations Associated With Maternal Depressive Symptoms?” Acad Ped 15(3): 319–25.
15. Kingston D., S. Tough, H. Whitfield. 2012. “Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review.” Child Psychiatry and Human Development 43(5): 683–714.
16. Von Korff, M., D. Goldberg. 2001. “Improving Outcomes in Depression.” British Medical Journal 323:948–9.
17. Gilbody, S., P. Bower, J. Fletcher, D. Richards, A.J. Sutton. 2006. “Collaborative Care for Depression: A Cumulative Meta-Analysis and Review of Longer-Term Outcomes.” Archives of Internal Medicine 166(21):2314–21.
18. Thota, A.B., T.A. Sipe, G.J. Byard, C.S. Zometa, R.A. Hahn, L.R. McKnight-Eily, D.P. Chapman et al. 2012. “Collaborative Care to Improve the Management of Depressive Disorders: A Community Guide Systematic Review and Meta-Analysis.” American Journal of Preventive Medicine 42(5):525–38.